Presentation on theme: "Dr. Yasser A. Salem Lecturer of Anesthesia & ICU Ain Shams university"— Presentation transcript:
1 Dr. Yasser A. Salem Lecturer of Anesthesia & ICU Ain Shams university Electrical BurnDr. Yasser A. SalemLecturer of Anesthesia & ICUAin Shams university
2 Management of electric burns Initial Assessment & ManagementAirwayBreathingCirculationDisabilityExpose & ExamineHistory
3 Initial Assessment & Management Stop the Burning ProcessNeutralize the heat sourceRemove smoldering clothing
4 Airway Assess patency of airway consider the presence of smoke inhalation injury and carbon monoxide toxicity if smoke is present
5 BreathingAssess adequacy of breathing efforts (is there labored breathing, wheezing?)Remember that the electrical current can impair the ability to breathe Initiate respiratory assistance, if needed
6 Circulation Electrical burn to muscle acts like a crush injury Shock from heart damage could be seen within minutesIV line placement and fluid administrationCardiac monitoring is indicated with electrical injuryCPR and defibrillation per diagnosis and protocolMonitor pulse in extremities with contact point burn or thermal injury; looking for muscle or skin swelling, impairment to local circulation (compartment syndrome)
9 Disability Brain and nerve deficits are a common problem Determine status of consciousness and treat accordingly Are all four extremities moving?
10 Expose & ExaminePresence of contact point burns (if present then patient must be transported to a hospital, preferably a burn center due to the risk of the “hidden” injury)Assess for presence of arc or flash burnsAssess for other traumatic injuries
11 History Contact time and exposure Voltage of electrical injury History of other traumatic injury
13 Components of electric injury First componentThe injury caused by the electrical current itself. The current generates intense heat often in excess of 2000°F along its path through the body .
14 Components of electric injury Second componentThe injury from "arcing". Ionization of air particles associated with a voltage drop is called arcing. The heat generated in the arc can be as high as 4,000°C and can vaporize metal. This process frequently causes a patient’s clothing to ignite and cause flame burns. A form of explosion dissipates excess energy from the arc.
15 Components of electric injury Third componentThe skin burn caused by a flash. A flash can result from the power source or from the ignition of clothing or surroundings.
16 Components of electric injury Fourth componentTraumatic injury caused by the intense muscle spasm with the current or from a fall. There is also a variety of cardiac, lung muscle, nerve and internal organ injuries
17 Types of electric burns 1-High Voltage Injurydefined as exposure to a voltage of 1000 volts or greater (damage beneath the surface should be suspected).
18 Types of electric burns 2-Low Voltage InjuryLow Voltage is defined as less than 500 volts (local heat damage is usually evident e.g. at the edge of the mouth in kids biting electric cords)Current not sufficient to cause tissue damage along its course except at contact siteCardiac problems are common e.g. ventricular fibrillation
19 Important NoteThe term “entrance and exit” sites are commonly used to describe the damage at a contact point with the electricity. These terms are really a misnomer when describing a high voltage AC current injury as the current is actually passing back and forth between contact with electricity and grounding site on the body. Low-voltage injuries usually only have a small burn (or no damage) at the point of contact.
21 Injuries caused by high voltage electric burns 1-Injuries along pathway of Current2-Skin Injury (Contact points)3-Body Burns4-Muscle Damage5-Heart & Blood Vessel Injury6-Lung Injury7-Neurologic Injury8-Orthopedic Injury
22 1-Injuries along pathway of Current Ventricular FibrillationOther rhythm abnormalitiesRespiratory arrestSeizures/ComaMental changesHypertensionRetinal detachmentCataract (delayed)Muscle necrosisFracturesHemolysisRenal FailureHemorrhageLimb lossAnemiaParesis/paralysis etc.
26 5-Heart & Blood Vessel Injury Immediate cardiac arrest is the most common cause of death.High voltage current has a reported immediate mortality of 60%.The initial heart problems are often reversible with CPR.High blood pressure is also quite common immediately after injury.
27 6-Lung InjuryImpairment of the brain centers stimulation of breathing and severe central nervous system damageDecreased muscle activity in the chest wall caused by a chest burn or muscle damage
28 7-Neurologic InjuryAcute central nervous system damage with coma, seizures, motor and, to a lesser extent, sensory deficits are well described. Many of these abnormalities are permanent.
29 8-Orthopedic InjuryOrthopedic injuries occur as a result of three processes:Muscle spasm-induced fractures and dislocationsHeat-induced local bone destructionDevascularizaton of bone
31 Injuries caused by law voltage electric burns Cardiac ProblemsMuscle SpasmOral Burn
32 Cardiac ProblemsThe most severe injury is electrocution as a household current applied to wet skin is sufficient to cause ventricular fibrillation and cardiac arrest (only 60 milliamps is required). Other rhythm disturbances can also occur.
33 Muscle SpasmTetany and spasm can also develop with contact with low voltage. The “can’t let go” current is only 30 milliamps.The spasm in the flexor muscles in the hand and forearm prevents the victim from letting go.Suffocation can also occur if the chest muscles go into spasm as the victim can’t breathe.This problem is most commonly seen with immersion in water like a bath tub.
34 Oral BurnLow-voltage electricity is the leading cause of electrical injury in childrenSucking an extension cord is responsible for more than half of the injuries, and biting on an electric cord accounts for about 30%Bleeding from labial artery at the edge of the mouth is a common occurrence (20%) during the period of slough (7 to 21 days) and should be anticipated. Pressure control of bleeding will be necessary.
36 Case report Electrical burn J.Y. Yang, Y.C. Tsai,M.S. Noordhoff Department of Plastic Surgery,Chang Gung Memorial Hospital, Taipei, Taiwan 105, Republic of ChinaAccepted 3 September Available online 24 May 2005.A 37-year-old female patient suffered high voltage electrical injury with resultant exit wound on the left quadrant of the abdomen measuring 15 × 10 cm2 involving full thickness of the abdominal wall including the peritoneum. Early debridement and exploratory laparotomy was performed on the fifth post-burn day although the patient had no abdominal symptoms. All visceral organs were grossly normal. The peritoneum was closed and the wound covered with split thickness skin graft. On the twelfth post-burn day the anterior wall of the stomach sloughed and resulted in a 10 × 10cm2 gastrocutaneous fistula. After 1 month of duodenostomy feeding via the fistula using a Foley catheter, the fistula was closed and was covered with greater omental flap and split thickness skin. Seventeen days later the patient was discharged following an uneventful recovery.
37 Paraplegia in an electrical burn: a case report We report a case of direct electrical injury to the lung parenchyma, without evidence of any thoracic wall contact injury, in an electrician who sustained a 20 kV-electrical shock while working in a substation cubicle. The diagnosis of a true electrical burn of the left lower lobe was suggested early on by imaging and then confirmed by surgical exploration, histological findings and the significant improvement of the patient’s condition following resection of the infarcted lobe. All possible causes of bronchial and pulmonary pathologies in such a context were ruled out. The fatal outcome of two previous similar cases and the generally high mortality of any electrical visceral injury support early surgical management as the only rational life-saving treatment. Current pathophysiological knowledge substantiates the theory of an isolated visceral injury located far away from the contact wounds. However, the pathogenesis of such severe injuries is not entirely understood.Paraplegia in an electrical burn: a case reportA.H.N. RobertsStoke Mandeville Hospital, Aylesbury, UKAccepted 31 July Available online 31 May 2005.A high voltage electrical burn of lung parenchyma M.J Masanès, E Gourbière , J PrudentAccepted 6 March Available online 31 July 2000.
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